Dysphonia, also known as hoarseness, is a very common disorder affecting the voice. It occurs when sounds cannot be produced normally due to problems with the structures involved in voice production.
The vocal cords (voice box) play the central role, but other parts of the body – including the lungs, trachea (windpipe) and mouth – also contribute to how the voice is shaped.
There are many possible causes, ranging from simple infections such as viral laryngitis through to more serious conditions including cancer. Ongoing or persistent hoarseness should always be assessed by a specialist to determine the underlying cause.
What are common causes?
Viral laryngitis
Inflammation of the voice box caused by an upper respiratory tract infection (such as a cold).
Muscle tension dysphonia
Occurs when the muscles around the voice box are overused or used incorrectly, rather than relying on the vocal cords themselves.
Vocal nodules (singer’s nodules)
These are small areas of thickening on the vocal cords caused by strain or overuse. They are commonly seen in singers and those who regularly use their voice heavily, such as coaches or teachers.
Gastro-oesophageal Reflux Disease (GORD)
Reflux can affect more than just the oesophagus. Stomach acid can reach the throat and voice box, causing irritation and swelling of the vocal cords; it can also impact healing after surgery.
Laryngeal cancer
Laryngeal cancer, or cancer of the voice box, most often occurs in people over the age of 40 with a history of smoking, although it can occasionally develop in non-smokers. When detected early, outcomes are generally very good.
Dr Phillips is experienced in the assessment and management of voice disorders. Any ongoing or concerning change in voice should be discussed with a general practitioner for further evaluation.
Snoring is a sound produced during sleep when airflow becomes turbulent as it passes through the upper airway. The vibration of surrounding tissues creates the characteristic noise.
What is the cause of snoring?
Snoring usually has more than one contributing factor. Common causes include:
Nasal obstruction
Enlarged tonsils
Excess or relaxed tissue in the soft palate
A relatively large tongue
Sedative medications
Alcohol
Increased body weight
What can be done about snoring?
Management of snoring generally starts with identifying and treating any nasal blockage, as this can play a significant role. If snoring persists, further assessment is often focused on the soft palate and other areas of the airway that may be contributing.
Does soft palate surgery work?
In carefully selected patients, surgery on the soft palate can be very effective in reducing snoring. It is not suitable for everyone, but when the anatomy is appropriate, outcomes are often favourable. Assessment by an ENT surgeon like Dr Phillips is required to determine whether this type of procedure is likely to be beneficial.
Rhinosinusitis refers to inflammation affecting the lining of the sinuses around the nose (paranasal sinuses).
Symptoms
Common symptoms include:
Nasal blockage
Runny nose
Post-nasal drip (mucus running down the back of the throat)
Reduced sense of smell
Facial pressure or discomfort
Rhinosinusitis can be divided into two main types: polypoid (where nasal polyps are present) and non-polypoid.
While the underlying causes may differ, initial treatment for both types usually involves nasal sprays and medications to reduce inflammation and improve drainage.
Surgery
Surgery is generally considered when your symptoms continue despite appropriate medical treatment. The aim of surgery is not only to open the sinuses but also to improve how well medications can reach the lining of your nose and sinuses.
The surgical procedure used to treat rhinosinusitis is known as functional endoscopic sinus surgery (FESS).
Nasal obstruction refers to difficulty breathing through the nose with enough airflow. This is not considered normal and, in most cases, can be effectively treated.
Symptoms
Symptoms can vary. Some are more obvious, such as a feeling of a blocked nose, while others may be less direct, including:
Reduced sense of smell
Snoring
Runny nose
Waking with a dry throat
It is common for one nostril to feel more blocked than the other at times. This can be part of the normal nasal cycle, where tissue inside the nose (the inferior turbinates) naturally swell on one side while shrinking on the other, alternating throughout the day.
Management
There are two main approaches to managing nasal obstruction:
Nasal sprays
Surgery
In most cases, treatment begins with a trial of nasal sprays. This typically involves a combination of saline rinses (saline douche) and intranasal steroid sprays. These should be used consistently for around 6 weeks to assess their effectiveness.
If your symptoms do not improve with sprays, surgery may be considered. The specific procedure will vary depending on the cause of the blockage, but the overall aim is to improve airflow by increasing the space inside the nasal passages, while maintaining normal nasal function.
Many patients benefit from a septoplasty (to straighten the septum) combined with a turbinoplasty (to reduce the size of the turbinates). In more complex cases, or where previous surgery has not been successful, a functional rhinoplasty may be recommended.
For further information about treatment options, an appointment can be arranged with Dr Phillips.
Your pain should usually be quite manageable at this stage, as local anaesthetic is placed in the surgical area. It is important to start eating and drinking early, along with taking pain relief. The local anaesthetic will gradually wear off over about 10 hours.
Day 1:
This is often the most uncomfortable day. Regular pain relief is important. Keeping hydrated is important, so regular fluid intake and icy poles can help. Your throat will have stitches, and a white coating may be visible – these are both normal. Swelling of the uvula (the small tissue at the back of the palate) is also common.
Day 2 – 3:
Pain relief should continue to be taken regularly, even your pain feels under control. Staying well hydrated is essential. Eating is encouraged but not as important as drinking fluids. Icy poles can continue to provide relief. Bad breath is common during this stage and is also normal.
Day 3 – 7:
Pain relief can usually be reduced and taken only as needed.
Day 7 – 10:
A temporary increase in pain for about 24 hours can occur during this time, which is normal and expected. Regular pain relief during this time is recommended and symptoms will usually settle again afterwards.
Frequently asked questions
Pain relief?
Panadol: Should be taken regularly for the first 3 days, even if your discomfort is mild.
Ibuprofen (Nurofen): Can be taken together with Panadol if needed, provided you have no allergies or history of asthma. It is best taken with food and limited to no more than three times a day to reduce the risk of stomach irritation.
Endone: Reserved for more severe pain if other options are not sufficient.
Prednisolone: Rarely if pain is extreme a dose of steroid medication may be prescribed.
Do I need antibiotics?
A white coating over the throat and the presence of bad breath are expected after this procedure. Feeling as though there is a mild cold is also common. These symptoms are part of the normal process and do not usually mean infection, so antibiotics are not required in most cases.
How much water should I drink?
A minimum of 3 litres of water each day is recommended to support recovery.
What should I eat?
There are no strict dietary restrictions following a UPPP. Eating and drinking can be guided by comfort; softer foods are often easier to manage. Some foods may cause discomfort – such as citrus, toast, or spicy dishes – but they will not cause harm if eaten.
How much time do I need off work?
Most people take around two weeks off work. Returning earlier is possible, but your energy levels and comfort are usually reduced during the first week.
What do I do if I get bleeding?
Experiencing a small amount of bleeding is common after surgery. Around day 7, it is not unusual to notice a small amount of blood, often about 1ml. If this occurs, a cold drink and an icy pole may help settle it.
If bleeding continues or increases, it is important to find care at the nearest hospital with an Emergency Department, ideally also with ENT services available.
Septoplasty (straightening of the nasal septum) combined with turbinoplasty (reduction of the inferior turbinates) is the most commonly performed procedure to treat a blocked nose.
Septoplasty involves gently lifting the lining inside the nose to access the septum, which is the cartilage dividing the nasal passages. The bent or misaligned portion is then straightened or removed. The incision is made inside the nose, so there are no visible external cuts or bruising. This procedure is performed under general anaesthetic and usually takes around 60 minutes, although can be longer if a more extensively deviated septum is addressed.
In most cases, septoplasty is performed by Dr Phillips as a completely endoscopic minimal access procedure. This together with reduction of the turbinates can often be done as day case surgery when done entirely endoscopically. In more advanced cases a one night overnight hospital stay may be recommended.
The nasal turbinates can be enlarged or swell due to a range of conditions, particularly from allergies such as allergic rhinitis. Turbinoplasty involves carefully lifting the lining over these structures and reducing their size by removing some of the underlying bone.
This surgery is generally not associated with significant pain and is commonly performed as a day procedure. Some, mild blood stained ooze bleeding is expected during the first week which usually settles on its own. A saline douche (saltwater rinse) such as FLO post op sinus rinse is required for around 6 weeks after surgery to support healing.
Overall, the procedure is more than 90% effective in improving nasal blockage.
Before the procedure
Before surgery, a detailed assessment of the nose is required. This includes a thorough discussion of symptoms along with a physical examination. In most cases, a nasal endoscopy is performed using a small camera to assess the back of the nasal passages.
Tests to measure airflow through the nose (rhinomanometry) are also commonly carried out for patients undergoing septal or turbinate surgery.
Prior to the operation, there will be a detailed discussion outlining the surgical plan and what to expect during recovery.
During the procedure
The operation is usually performed through very small incisions made inside the nose. In some cases, particularly when the septal deviation is located towards the front of the nose, a small external incision may be required on the columella (the tissue between the nostrils).
Once the deviated section of cartilage has been corrected or removed and any necessary grafts have been placed, the incisions are closed. The septum is then positioned centrally. Silicone splints may sometimes be placed inside the nose to provide support during healing if there has been very extensive surgery required.
The turbinates are reduced using specialised endoscopic instruments. Dissolvable packing is often used to minimise bleeding. This gradually clears with the help of saline rinses in the weeks following surgery, supporting proper healing.
Post procedure recovery
Most patients can go home on the same day as surgery without needing to stay overnight. Depending on whether splints or packing have been used, a short course of antibiotics may be prescribed, but mostly is not required.
If splints are inserted, they are typically removed about one week after surgery. A further follow-up appointment is usually arranged at around 4 to 6 weeks.
Some bleeding during the first week is normal, although significant bleeding requiring readmission to hospital is uncommon. Pain is usually mild and can be managed with simple medications such as paracetamol and ibuprofen.
What’s next?
After recovery, the nasal blockage that led to surgery should be noticeably improved. In some cases, repeat nasendoscopy and surveillance of sinuses may be required.
Laryngoscopy is a procedure performed under local anaesthesia sprays in the rooms to look at and examine deeper structures of the throat pharynx and vocal cords.
Micro laryngoscopy
This is performed in hospital under brief general anaesthesia to examine the throat, pharynx, larynx (voice box) and vocal cords. During this procedure, detailed photo documentation of any lesions is performed prior to any biopsy or removal of abnormal tissue and this is sent for pathology testing. It is typically done as a day procedure, allowing patients to go home the same day. Results of biopsies typically take around 1 week to get a full and finalised report.
Cancers affecting the head and neck are the sixth most common type of cancer. Achieving the best outcomes depends on accurate diagnosis, effective treatment and ongoing follow-up, all of which rely on both surgical expertise and a coordinated approach to care.
Management typically involves a team of healthcare professionals, including radiation and medical oncologists, general practitioners, dentists, and allied health providers such as speech pathologists, physiotherapists and dietitians. Working together, this team aims to provide comprehensive care and support.
Head and neck cancers can develop from the skin or from the lining inside areas such as the mouth, nose, sinuses, throat, tonsils and airway. They may also arise from glands in this region, including the parotid, submandibular and thyroid glands. These cancers often present with local symptoms such as pain or the feeling of a lump. In some cases, they may spread to nearby lymph nodes, appearing as a swelling in the neck.
Symptoms
Symptoms that may require further assessment include:
Ulcers in the mouth that do not heal
Pain or difficulty when swallowing
Changes in the voice
A lump in the neck
Risk factors vary depending on the type and location of the cancer.
Skin cancers, including both melanoma and non-melanoma types, are strongly linked to sun exposure.
Cancers of the mouth and throat are more commonly associated with lifestyle factors such as smoking and alcohol use. In recent years, certain viruses have also been linked to the development of some head and neck cancers, particularly in younger and otherwise healthy individuals. Early medical review of concerning symptoms is important, as early detection is associated with better outcomes.
Multidisciplinary Treatment
Dr Phillips provides specialised care in the diagnosis and treatment of head and neck cancers. Care is delivered in close collaboration with oncologists and allied health professionals to ensure all aspects of treatment and recovery are carefully managed. A multidisciplinary approach is prioritised, with coordination across both private care settings and services such as the Olivia Newton-John Cancer Centre at Austin Health.
Head and neck surgical procedures offered include for cancers affecting internal linings, lymph node surgery in the neck, and procedures involving glands such as the salivary glands (parotid and submandibular) and the thyroid.
Functional endoscopic sinus surgery (FESS) is a surgical procedure performed through the nostrils to open the sinus passages providing relief for many patients with chronic sinusitis with or without nasal polyps.
Over the past 10 years, there have been major improvements in how this surgery is done. Better imaging, more precise surgical techniques, specialised instruments, advances in anaesthesia, and closer follow-up care have all led to much better outcomes for patients.
Dr Phillips has extensive training in endoscopic sinus surgery and takes a careful, detailed approach.
Most patients who are suitable for this surgery will have already tried appropriate medical treatments for their sinus condition before surgery is considered.
The way sinus surgery is performed has changed significantly over the last 10 years. The focus is now on restoring normal sinus function by opening blocked areas and treating all affected sinuses.
Older methods, sometimes described as a “sinus scrape,” often did not give lasting relief. Current techniques aim to properly open the affected sinuses so they can drain, be appropriately cleaned, and be easily monitored in the rooms after surgery.
In some cases, image-guided technology is used during the procedure to ensure all diseased areas are treated. After surgery, nasal packing is often not needed. In the past, removing nasal packs caused significant discomfort, but this is now uncommon.
With improvements in both surgery and anaesthesia, significant bleeding is also unusual during and after the operation. As result, many patients are able to go home the same day, although an overnight stay may occasionally be recommended if the surgery is more extensive.
After surgery, regular saline rinsing is recommended as an important part of recovery. A low-pressure, high-volume rinse should be used 4 times a day for at least 2 months. Follow-up appointments are also essential, allowing the sinuses to be checked and any remaining debris that has not been washed out by the saline to be gently cleared.
Further information about recovery can be found in the post-operative handouts.
To discuss endoscopic sinus surgery further, an appointment can be made with Dr Phillips.
Post operative instructions
What to expect
Immediately post op:
A small piece of gauze is usually placed under your nose after surgery. Breathing through your nose is often fairly comfortable at this stage. Pain is usually mild due to the local anaesthetic used during the procedure.
Day 1:
Some blood-stained fluid may ooze from your nose overnight. This is normal and does not mean there is active bleeding. Your nose may feel more blocked compared to immediately after surgery because of this ooze of blood and serous fluid. You can change the gauze under your nose as necessary (eg. if it becomes full).
You may occasionally have 2 small, clear splints present inside your nose if there has been extensive septal deviation correction during the same operation, held in place with stitches.
A saline wash bottle will be provided to you by the nurses and should be started on this day. This step is as important as the surgery for healing. The bottle should be filled with cooled, previously boiled water, and the supplied solvent should be added.
While leaning over a sink, insert the bottle into your nostril and gently squeeze the bottle. A lot of the fluid will run through and come out of the nose, which is expected. Half the bottle should be used on each side. This should be done at least four times a day for about three months.
At night:
Taking pain relief before bed on the first night can help you with comfort. Sleeping with your head raised on two pillows is recommended. A towel on the pillow and gauze under your nose can help catch any drainage and protect the skin.
Day 2 – 7:
During this time, it is common to feel as though there is a cold, with nasal blockage and congestion. Some numbness around the tip of the nose and upper lip may also be noticed. This is normal and settles with time.
Day 8 – 10:
If splints are present in your nose, they are usually removed at the first follow-up visit. Breathing often improves straight away, and the feeling of congestion reduces. If there are no splints used your first follow-up visit will be scheduled around 2-3 weeks post op.
Any concerns or unexpected changes should be addressed promptly by contacting the clinic, where support is readily available during the recovery period.
Frequently asked questions
Pain relief?
FESS is generally not a very painful procedure. A feeling of pressure or fullness in the sinuses is more common than pain after surgery in most people.
Regular pain relief is recommended for the first 24 hours, then taken as needed.
Anti-inflammatories such as ibuprofen or Celebrex along with regular paracetamol will be recommended. Stronger pain relief will be provided for you from the hospital pharmacist to use if required with written instructions.
Antibiotics?
Antibiotics are not usually prescribed after FESS. There is little evidence for benefit in average uncomplicated cases.
What should I eat?
A normal diet can be resumed after surgery.
What are the activities I shouldn’t do?
No very hot showers or baths – 72 hours
No heavy lifting or nose blowing – 7-10 days
No vigorous or strenuous exercise – 7-10 days
No blood thinning medication – 2 weeks or until advised by your surgeon.
How much time do I need off work?
Most individuals require around one week away from lightwork, although this may vary depending on recovery or if a more strenuous work is undertaken.
How important is the wash bottle?
Regular use of the wash bottle is essential following this procedure. It plays a critical role in supporting healing of the nasal lining after surgery. Use at least 4 times daily is required, though more frequent use – up to 10 times per day – may provide additional benefit without causing harm.
Using the wash bottle more than 4 times per day will not result in any harm.
What do I do if I get bleeding?
If bleeding occurs, start by using a wash in the nose. Sit leaning forward with your mouth open, applying firm pressure to the sides of your nose down at the tip for a total of 10 minutes. Use of ice packs over the nose may also be helpful. If this is unsuccessful after 10 minutes, then give yourself another wash. If bleeding persists, seek care at the nearest public hospital with an Emergency Department.
